Enrollment Forms Packet (EFP)

Transcripción

1 Enrollment Forms Packet (EFP) Please review the information below. Based on your student(s) grade and applicable circumstances, you are required to submit documentation in order to complete this step in the enrollment process. You can fax, scan and , or mail the required paperwork. Important Note: Please send copies, do not mail the original documents Texas Virtual Academy Enrollment Processing Center 2300 Corporate Park Drive, Ste 200 Herndon, VA Ph Fx Fax (preferred): Scan and Mail: Texas Virtual Academy 2300 Corporate Park Drive, Ste 200 Herndon, VA Required For? Item Description Provided by? Proof of Prior Texas Public You must submit a proof of enrollment in a Texas public school for the school year. Acceptable documents: Report Card, Transcript, Progress Report, Withdrawal Form, or Verification of Enrollment form (provided in this ) filled out by your students previous school personnel. Provided by you Proof of Age Official Birth Certificate (not the hospital issued certificate). Provided by you Legal Guardian Drivers License or State ID Proof of Residency Please submit a copy of the Legal Guardian s Drivers License or State ID. Two forms of Proof of Residency: Current Lease Agreement including signature page, Mortgage Statement, Most Recent Property Tax Statement, Current Utility Bill showing service address or Current Texas Driver s License. Provided by you Provided by you Proof of Internet Complete Internet bill. Provided by you Immunization Record Complete Immunization Record (Birth to present) Document must be official record from medical provider or IMMTRAC. Proof of Immunization from previous school records are not acceptable. Provided by you Special Education At Risk Indicators Required for all Students Ethnicity and Race Questionnaire Home Language Survey/ ESL Parent Permission Student Enrollment Application Affidavit of Student Residency Notice of Compulsory Attendance Law/Disciplinary History/Occupational Survey Student Health History Student Record Release By filling out this form, you are giving our school permission to request your student s official records from their previous school after the approval process. If your child was Homeschooled please indicate it on the form, fill out the top portion and sign it. Section 504 Plan Emergency Care Consent Form Required for all rising High School Students Transcript - High School Students must provide unofficial transcript You will need to request an unofficial transcript from your student's current school which will show academic standing. This is required in order to place all 10 th -12 th graders. Once your student is approved we will receive the official transcript directly from the school. Provided by you IEP (latest document) A copy of your student's current IEP (Individualized Education Plan). Because the IEP expires yearly, please submit the current IEP. Provided by you Required for students with Special Programs Evaluation Report (latest document) The Evaluation Report is valid for 3 years. If you do not have a copy of your student's ER, you can request a copy form your student's current school. Provided by you Recommended for 3 rd, 5 th and 7 th Graders Recommended for 6 th and 9 th Graders Recommended for All Students 504 Accommodation Plan Vision and Screening Hearing A copy of your student's current 504 Accommodation Plan. Because the 504 expires yearly, please submit the current 505 Accommodation Plan Please submit proof that your student has completed their vision and hearing screening from previous school. Provided by you Provided by you Spinal Screening Please submit proof that your student has completed their spinal screening from previous school. Provided by you Report Card The most recent Report Card Provided by you Social Security Card Please note do not send actual card, please submit a copy Provided by You If Applicable Mckinney-Vento Eligibility Questionnaire Complete this form and submit

2 Student Last Name, First DOB TXVA SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended? Check One: Yes No If Yes, then please complete the following: Check all that apply: Content Mastery/Resource Room Counseling Speech Therapy Occupational/Physical Therapy Behavior Adjustment Class Other: Please Specify: What is Student s disability? If No, then please complete the following: Has Student ever received Special Education services? Check One: Yes No If Yes, please specify school name, year, and disability/condition (if known):

3 SCHOOL YEAR AT-RISK INDICATORS/DOCUMENTATION Student Name A student at risk of dropping out of school includes each student who is under 21 years of age and who: (Check yes or no to all questions) YES NO 1. Is in prekindergarten, kindergarten or grade 1, 2, or 3 and did not perform satisfactorily on a readiness test or assessment instrument administered during the current school year. 2. Is in grade 7, 8, 9, 10, 11, or 12 and did not maintain an average equivalent to 70 on a scale of 100 in two or more subjects in the foundation curriculum during a semester in the preceding or current school year or is not maintaining such an average in two or more subjects in the foundation curriculum in the current semester. 3. Was not advanced from one grade level to the next for one or more school years. 4. Did not perform satisfactorily on an assessment instrument [TAAS/TAKS] administered to the student under TEC Subchapter B, Chapter 39, and who has not in the previous or current school year subsequently performed on that instrument or another appropriate instrument at a level equal to at least 110 percent of the level of satisfactory performance on that instrument. 5. Is pregnant or is a parent. 6. Has been placed in an alternative education program (DAEP) in accordance with TEC during the preceding or current school year (Disciplinary Alternative Education Placement). 7 Has been expelled in accordance with TEC during the preceding or current school year. 8. Is currently on parole, probation, deferred prosecution, or other conditional release. 9. Was previously reported through the Public Education Information Management System (PEIMS) to have dropped out of school. 10. Is a student of limited English proficiency, as defined by TEC Is in the custody or care of the Department of Protective and Regulatory Services or has, during the current school year, been referred to the department by a school official, officer of the juvenile court, or law enforcement official. 12. Is homeless, as defined by 42 U.S.C. Section 11302, and its subsequent amendments; or 13. Resided in the preceding school year or resides in the current school year in a residential placement facility in the district, including a detention facility, substance abuse treatment facility, emergency shelter, psychiatric hospital, halfway house, or foster group home. The student is at-risk. (Check Yes or No) : School Official: : :

4 Student Last Name, First DOB TEXAS PUBLIC SCHOOL STUDENT TXVA ETHNICITY AND RACE DATA QUESTIONNAIRE The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC). School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting. Please answer both parts of the following questions on the student s or staff member s ethnicity and race. United States Federal Register (71 FR 44866) Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one) Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Not Hispanic/Latino Part 2. Race: What is the person s race? (Choose one or more) American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment. Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Black or African American - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. The school does not discriminate on the basis of sex; national origin; ethnicity; religion; disability; academic, artistic, or athletic ability; or the district the child would otherwise attend. We reserve the right to deny admission to a student who has a documented history of a criminal offense, a juvenile court adjudication, or disciplinary problems under Subchapter A, Chapter 37, Texas Education Code.

5 Student Last Name, First DOB TXVA HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll in a school in the United States? (MM/YYYY) In what city, state, and country was the student born? En qué mes y año se inscribió el estudiante por primera vez en Los Estados Unidos? (Mes/Año) En qué ciudad, estado, y país nació el estudiante? What language is spoken in your home most of the time? Cuál es el idioma que más se habla en su casa? What language does the student speak most of the time? Cuál es el idioma que más habla el estudiante? Does the parent or guardian need to communicate with the school in a language other than English? Check One: Yes No If Yes, write the name of the language. Necesitará el padre, la madre, o el guardián comunicarse con la escuela utilizando un idioma que no sea el Inglés? Si No Si es así, favor escribir el nombre del idioma. TXVA ESL PARENT/GUARDIAN PERMISSION I, the undersigned, do hereby give permission for my child to receive extra help in English as a Second Language as part of a School English as a Second Language (ESL) program if he/she is found to be limited in either oral or cognitive and academic English proficiency skills. If any language other than English is spoken at home, the school will follow the Texas Education Agency s Language Proficiency Assessment Committee Framework Policy to identify whether or not my child is limited in English Proficiency skills as required by Texas State Law. [Para aquellos que hablan Español (For those who speak Spanish):] Yo, (nombre del padre, madre, o guardian) doy permiso para que mi hijo/a (nombre del niño/a) reciba instrucción en el Programa de Inglés como Segundo Idioma si en él/ella se encuentre una proficiencia limitada en el idioma de Inglés. Please sign below (Por Favor de firmar abajo): Parent/Guardian Name (Nombre del Padre, Madre, o Guardián) (Fecha)

6 TXVA STUDENT ENROLLMENT APPLICATION GENERAL INFORMATION Student s Legal Name (Last, First, Middle) Application (MM/DD/YYYY) Primary Residence (Street Name, Building and/or Apt. #, City, State, ZIP) Home Phone Cell Phone Social Security No. ( ) Gender Check One: Male Female DOB (MM/DD/YYYY) Last Grade Completed SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISD Name) Note: Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level. Last School Student Attended (School Name) Last School (City) (State) (Zip) PRIMARY CONTACT INFORMATION Father s / Mother s / Guardian s Name (Last, First, Middle) Living with Student? Check One: Yes No Primary Residence (If Different From Student s Address) Home Phone Work Phone Cell Phone Driver s License (No. and State)

7 TXVA STUDENT ENROLLMENT APPLICATION Page 2 Student Last Name, First DOB PARENT/GUARDIAN INFORMATION CONT. Father s / Mother s / Guardian s Name (Last, First, Middle) Living with Student? Check One: Yes No Primary Residence (If Different From Student s Address) Home Phone Work Phone Cell Phone Driver s License (No. and State) ALTERNATE CONTACT INFORMATION Name (Last, First, Middle) Relationship to Student Home Phone Work Phone Cell Phone Name (Last, First, Middle) Relationship to Student Home Phone Work Phone Cell Phone Name (Last, First, Middle) Relationship to Student Home Phone Work Phone Cell Phone LEGAL ALERT Is anyone legally restricted from contact with Student? Check One: Yes No If Yes, then copies of the appropriate documents (e.g., court order, etc.) must be on file with the School.

8 TXVA AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last, First, Middle) Student s Residence (Street Name, Building and/or Apt. #, City, State, ZIP) Name of Individual With Whom Student Resides (Last, First, Middle) Relationship to Student Name of Individual With Whom Student Resides (Last, First, Middle) Relationship to Student Verification of Residency (Texas Education Code (c)): Please provide at least two (2) of the following documents in Parent s/guardian s name to show proof of residency at the address indicated in this Affidavit of Student Residency: Current Lease Agreement, Current Mortgage Statement, Most Recent Property Tax Statement, Current Utility Bill, or Current Texas Driver s License. Note: Documents showing evidence of any alteration will not be accepted. I certify that the information contained in this Affidavit of Student Residency is true and correct. TXVA VOLUNTARY PHOTO/VIDEO RELEASE I, the undersigned, do hereby give or grant permission to and assign all rights in and to any photographs, motion pictures, video footage, and/or audio recordings that may be taken of my child during his/her attendance at the School that may be used for promotional or training purposes. I hereby authorize Responsive Education Solutions, Texas Virtual Academy and K12 to reproduce, copy, exhibit, publish, and distribute any and all photographs, motion pictures, video footage, and/or audio recordings for the sole purpose of promoting the School learning system and/or the training and professional development of staff. I certify that I am over the age of twenty-one (21). I understand that signing this Voluntary Photo/Video Release is NOT a condition of enrollment.

9 Student Last Name, First DOB TXVA NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section of the Texas Education Code, children between the ages of six (6) and their 18 th birthday are required to attend school on a daily basis unless specifically exempted by Section A child who is required to attend school under this section shall attend school each day for the entire period the program of instruction is provided. The law places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly. Any parent or person failing to require his child to attend school as required by law may be subject to a fine an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense. Section states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourweek period. The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities. By signing below I am acknowledging the receipt of this notification. I acknowledge that I have received the Notice of Compulsory Attendance Law. DISCIPLINARY HISTORY Does the student have a documented history of a criminal offense? Check One: Yes No If Yes, please explain. Does the student have a documented history of any juvenile court actions (including any deferred actions?) Check One: Yes No If Yes, please explain. Does the student have a documented history of DAEP (disciplinary alternative education placement)? Check One: Yes No If Yes, please explain. TXVA OCCUPATIONAL SURVEY Within the past three (3) years, has your child(ren) traveled or moved alone with a parent, relative, guardian, or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment? Check One: Yes No If Yes, then please check the type of employment: Farming Ranching Fencing Dairying Fishing Picking fruit or vegetables Cotton farming/ginning Combining/harvesting grain Driving tractors, machinery Tree growing or harvesting Food processing in plants Plant nursery Poultry production Clearing land Picking pecans, etc. Bailing hay Other similar work

10 TXVA STUDENT HEALTH HISTORY Name: Age: Birthdate: Address: Phone Number: 1. Please identify if student has had the following diseases by writing the age he/she had the disease on the line: Chickenpox: Measles: Mumps: AGE AGE AGE 2. Were there any issues during pregnancy, labor and/or delivery for this child? Yes No 3. Does this child have an ongoing health concern? (Asthma, Diabetes, Etc.) Yes No If yes, please describe: 4. Does this child have any allergies? Yes No If yes, please list: Has the allergy required emergency treatment? If yes, please explain: Yes No 5. Is there a history of any hospitalizations, significant injuries or surgery? Yes No If yes, please describe: 6. Are there any current medical concerns/injuries? Yes No Asthma or Lung Problems Fracture/Dislocation/Strain Ulcers/Digestive Depression/Mental Health Issue Hearing Aid/ Orthopedic Braces Skin/Toes Diabetes/Hepatitis Head Injury Surgery Ear/Nose/Throat Heart Problems Other (ADHD, AIDS, etc.): Epilepsy/Seizures Kidney/Urinary Problems For each condition checked above, please indicate if it is past or present condition, the treating physician s name and phone number, and current medication requirements and purpose: 7. Is the student pregnant? Yes No If yes, expected due date: 8. Does this child take any medication regularly at home? Yes No Requires medication at school? Yes No If yes to either, please describe: NOTE: Medication will not be administered to student at school except as provided for in school s Medication Policies, which may be found in the Parent/Student Handbook. Any additional concerns or pertinent information (use back as needed):

11 STUDENT RECORD RELEASE DATE To Releasing School Counselor or Registrar: School Name: School Address: City, State, Zip: School Telephone: (_ )_ Fax Number: (_ )_ The following student has withdrawn from your school. Student of Birth Student ID # Please forward the following information on the above student: Official Transcript Academic Records Testing Scores/Assessment Health Records Special Ed Classification / Documents 504 Evaluations and Plan Copy of Social Security Card Copy of Original Home Language Survey and LPAC records _Copy of Birth Certificate Other Please respond to the following address: Texas Virtual Academy Attn: Student Records Dept Lakeway Drive, Suite 250B Lewisville TX, Office Fax Signature of Guardian or Registrar

12 Student Last Name, First DOB TXVA SECTION 504 Was Student receiving Section 504 and/or Dyslexia services/accommodations at the last school Student attended? Check One: Yes No If Yes, then please complete the following: Check all that apply: Instructional Services Instructional Accommodations Testing/Assessment Accommodations Other: Please Specify: What is Student s disability? If No, then please complete the following: Has Student ever received Section 504 and/or Dyslexia services? Check One: Yes No If Yes, please specify school name, year, and disability/condition (if known):

13 Student Last Name, First DOB TXVA EMERGENCY CARE CONSENT FORM Emergency Contact s Name (Last, First, Middle) Note: Emergency Contact should be someone other than Student s Parent/Guardian. Relationship to Student Emergency Contact s Home Phone Emergency Contact s Work Phone Emergency Contact s Cell Phone Physician s Name (Last, First, Middle) Physician s Work Phone Is Student allergic to any medications? Check One: Yes No If Yes, please explain. In case the services of a physician are required before a parent/guardian can be reached, School officials are hereby authorized to take whatever action is deemed necessary for the health of my child. I also authorize School officials to directly contact the physician named above in case of an emergency. I will not hold the School or its staff responsible for emergency care and/or transportation for my child, and I will assume full responsibility for any costs related to such services provided to my child.

14 Office Use Only Computer: Yes No FRL status: Free Reduced Contact Attempt 1: / / Note: Contact Attempt 2: / / Note: MV Eligible: Yes No McKinney-Vento Eligibility Questionnaire Name of Student: First Middle Last Phone: Birth : Grade: Male Female Include Area Code Month/Day/Year Name of Parent / Guardian / Caregiver / Host / Self: Circle Relationship First Last Address: Street Address City State Zip This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C The answers to this residency information help determine the services the student may be eligible to receive. Eligibility must be reviewed and reevaluated every school year. Signature of Parent/Legal Guardian: : Permanent Housing: Is this student living in a housing situation that is -- Ex: family home, apartment- leasing, rental residence, own property / guaranteed bed at night / home occupancy is appropriate-- fixed (stationary/not subject to change) Yes No regular (used on a nightly basis) Yes No adequate (meets physical and psychological needs typically met in home environments) Yes No If you answered NO to ANY of the above, please complete the remainder of this form. If you answered YES to ALL of the above, please stop here. You are done with this form. Send in with the remainder of your enrollment documentation. Thank you! ==================================================================================== Temporary Housing: If this student is NOT residing in a fixed, regular, and adequate nighttime situation, where is the student presently living? (Check at least one box). Is this student currently living with a parent or legal guardian? In a Motel / Hotel Temporarily with another family in their home due to a lack of adequate alternatives (sometimes referred to as doubled-up ) In a place not designated for ordinary sleeping accommodations such as a car, park, bus, train or campsite Awaiting foster care placement Other temporary living situation (Please describe): How long has the student lived in the above residence? Is current living situation due to a hardship? Yes No If yes, please explain: Is the student currently living in a Shelter or Transitional Housing Program Yes No Do you work in agriculture and/ or does your residence depend on seasonal work? Yes No School Personnel: If the Temporary Housing portion of this form has been filled out, please fax a copy to the TXVA McKinney-Vento Liaison FAX

15 Verification of Enrollment Texas Virtual Academy Information as Reported to PID Student Legal Name: First Middle Last Student SSN or State ID: DOB: Grade: PREVIOUS SCHOOL PERSONNEL PLEASE COMPLETE THE INFORMATION BELOW: Above Student Enrolled On: Above Student Did Not Enroll Above Student Enrolled, but has withdrawn. Enrollment : Withdraw : School Name: Address: School Official: Signature Telephone: Today's Is student enrolled at this school under a different name? If yes, indicate name: Is student enrolled at this school under a different SSN or State ID? If yes, indicate number: Is student enrolled at this school under a different date of birth? If yes, date of birth: Yes Yes Yes No No No PLEASE FAX INFORMATION TO TEXAS VIRTUAL ACADEMY ATTN: Texas Virtual Academy Enrollment Processing Phone: (877) Corporate Park Drive Herndon, VA Fax: (877)

16 Texas Minimum State Vaccine Requirements for Students Grades K-12 This chart summarizes the vaccine requirements incorporated in the Texas Administrative Code (TAC), Title 25 Health Services, Sections to This chart is not intended as a substitute for consulting the TAC, which has other provisions and details. Click here for complete TAC language. The Department of State Health Services (DSHS) is granted authority to set immunization requirements by the Texas Education Code, Chapter 38, Health & Safety, Subchapter A, General Provisions. IMMUNIZATION REQUIREMENTS A student shall show acceptable evidence of vaccination prior to entry, attendance, or transfer to a child-care facility or public or private elementary or secondary school in Texas. Vaccine Required (Attention to notes and footnotes) Minimum Number of Doses Required by Grade Level K 4 th 5 th - 6 th 7 th 8 th - 11 th 12 th NOTES Diphtheria/Tetanus/Pertussis 5 doses or (DTaP/DTP/DT/Td/Tdap) 1 4 doses Polio 1 4 doses or 3 doses 5 doses or 4 doses 4 doses or 3 doses 3 dose primary series and 1 Tdap/Td booster within last 5 years 4 doses or 3 doses 3 dose primary series and 1 Tdap/Td booster within last 10 years 4 doses or 3 doses 4 doses or 3 doses Five (5) doses of diphtheria-tetanus-pertussis vaccine; one dose must have been received on or after the 4 th birthday. However, four doses meet the requirement if the 4 th dose was received on or after the 4 th birthday. For students aged 7 years and older, three doses meet the requirement if one dose was received on or after the 4 th birthday. For 7 th grade: one dose of Tdap is required if at least 5 years have passed since the last dose of tetanus- containing vaccine. For 8 th - 12 th grade: one dose of Tdap is required when 10 years have passed since the last dose of tetanus-containing vaccine. Td is acceptable in place of Tdap if a medical contraindication to pertussis exists. Four (4) doses of polio; one dose must be received on or after the 4 th birthday. However, three doses meet the requirement if the 3 rd dose was received on or after the 4 th birthday. Measles, Mumps, and Rubella 1,2 (MMR) 2 doses 2 doses 2 doses 2 doses Hepatitis B 2 3 doses 3 doses 3 doses 3 doses 3 doses Varicella 1,2,3 2 doses 1 dose 2 doses 1 dose Meningococcal 1 dose The 1 st dose of MMR must be received on or after the 1 st birthday. For K 4 th grade, two doses of MMR are required. For 5 th - 12 th grade, two doses of a measles-containing vaccine, and one dose each of rubella and mumps vaccine is required. For students aged years, two doses meet the requirement if adult hepatitis B vaccine (Recombivax) was received. Dosage and type of vaccine must be clearly documented. Two (2) 10 mcg/1.0 ml of Recombivax). The 1 st dose of varicella must be received on or after the 1 st birthday. For grades K 4 th and 7 th - 11 th, two doses are required. One (1) dose is required for all other grade levels. For any student who receives the 1 st dose on or after 13 years of age, two doses are required. Hepatitis A 1,2 2 doses The 1 st dose of hepatitis A must be received on or after the 1 st birthday Receipt of the dose up to (and including) 4 days before the birthday will satisfy the school entry immunization requirement. Serologic confirmation of immunity to measles, mumps, rubella, hepatitis B, hepatitis A, or varicella or serologic evidence of infection is acceptable in place of vaccine. Previous illness may be documented with a written statement from a physician, school nurse, or the child's parent or guardian containing wording such as: "This is to verify that (name of student) had varicella disease (chickenpox) on or about (date) and does not need varicella vaccine." This written statement will be acceptable in place of any and all varicella vaccine doses required.

17 Exemptions The law allows (a) physicians to write a statement stating that the vaccine(s) required would be medically harmful or injurious to the health and well-being of the child or household member, and (b) parents/guardians to choose an exemption from immunization requirements for reasons of conscience, including a religious belief. The law does not allow parents/guardians to elect an exemption simply because of inconvenience (for example, a record is lost or incomplete and it is too much trouble to go to a physician or clinic to correct the problem). Schools and child-care facilities should maintain an up-to-date list of students with exemptions, so they may be excluded in times of emergency or epidemic declared by the commissioner of public health. Instructions for requesting the official exemption affidavit that must be signed by parents/guardians choosing the exemption for reasons of conscience, including a religious belief, can be found at Original Exemption Affidavit must be completed and submitted to the school or child-care facility. For children claiming medical exemptions, a written statement by the physician must be submitted to the school or child-care facility. Provisional Enrollment All immunizations should be completed by the first date of attendance. The law requires that students be fully vaccinated against the specified diseases. A student may be enrolled provisionally if the student has an immunization record that indicates the student has received at least one dose of each specified age-appropriate vaccine required by this rule. To remain enrolled, the student must complete the required subsequent doses in each vaccine series on schedule and as rapidly as is medically feasible and provide acceptable evidence of vaccination to the school. A school nurse or school administrator shall review the immunization status of a provisionally enrolled student every 30 days to ensure continued compliance in completing the required doses of vaccination. If, at the end of the 30-day period, a student has not received a subsequent dose of vaccine, the student is not in compliance and the school shall exclude the student from school attendance until the required dose is administered. Documentation Since many types of personal immunization records are in use, any document will be acceptable provided a physician or public health personnel has validated it. The month, day, and year that the vaccination was received must be recorded on all school immunization records created or updated after September 1, Texas Department of State Health Services Immunization Branch MC-1946 P. O. Box Austin, TX (800) Stock # 6-14 Rev. 03/2013

18 Requisitos de vacunación mínimos estatales de Texas de para estudiantes de kínder-12. o grado Este gráfico resume los requisitos de vacunación incorporados en el Código Administrativo de Texas (o TAC), título 25, Servicios de salud, Secciones a El gráfico no tiene como propósito sustituir las consultas al TAC, el cual contempla otras disposiciones y detalles. Haga clic aquí para obtener el texto completo del TAC. El Código Educativo de Texas, capítulo 38, Salud y Seguridad, subcapítulo A, Disposiciones Generales, concede la autoridad de establecer requisitos de inmunización al Departamento Estatal de Servicios de Salud de Texas (o DSHS). Vacuna requerida (Vea las notas y las notas de pie de página) REQUISITOS DE INMUNIZACIÓN Los estudiantes deberán mostrar comprobantes de vacunación aceptables antes de entrar, asistir o ser transferidos a una guardería o escuela primaria o secundaria pública o privada de Texas. Difteria, tétanos y pertusis 5 dosis o (DTaP, DTP, DT, Td, Tdap) 1 4 dosis Polio 1 4 dosis o 3 dosis Sarampión, paperas y rubéola 1,2 (MMR) Número mínimo de dosis requeridas por nivel de grado Kínder - 4. o 5. o - 6. o 7. o 8. o o 12. o 5 dosis o 4 dosis 4 dosis o 3 dosis Serie primaria de 3 dosis y 1 dosis de refuerzo de la vacuna Tdap o Td en los últimos 5 años 4 dosis o 3 dosis Serie primaria de 3 dosis y 1 dosis de refuerzo de la vacuna Tdap o Td en los últimos 10 años 4 dosis o 3 dosis 4 dosis o 3 dosis 2 dosis 2 dosis 2 dosis 2 dosis Hepatitis B 2 3 dosis 3 dosis 3 dosis 3 dosis 3 dosis Varicela 1,2,3 2 dosis 1 dosis 2 dosis 1 dosis Meningocócica 1 dosis Hepatitis A 1,2 2 dosis NOTAS Cinco (5) dosis de la vacuna contra la difteria, el tétanos y la pertusis; debe haberse recibido una dosis en o después del 4. o cumpleaños. Sin embargo, con cuatro dosis se cumple con el requisito si la 4. a dosis se recibió en o después del 4. o cumpleaños. Los estudiantes de 7 años de edad o más, con tres dosis cumplen con el requisito si recibieron una dosis en o después del 4. o cumpleaños. Para el 7. o grado: se requiere 1 dosis de la vacuna Tdap si han pasado al menos 5 años desde la última dosis de una vacuna que contenga tétanos. Para los grados de 8. o -12. o : se requiere una dosis de la vacuna Tdap si han pasado 10 años desde la última dosis de una vacuna que contenga tétanos. La vacuna Td es aceptable en lugar de la vacuna Tdap si existe una contraindicación médica con respecto a la vacuna contra la pertusis. Cuatro (4) dosis de la vacuna contra la polio; debe recibirse una dosis en o después del 4. o cumpleaños. Sin embargo, con tres dosis se cumple con el requisito si la 3. er dosis se recibió en o después del 4. o cumpleaños. La 1. a dosis de la vacuna MMR debe recibirse en o después del 1. er cumpleaños. Para el kínder-4. o grado, se requieren dos dosis de la vacuna MMR. Para los grados de 5. o -12. o, se requieren dos dosis de una vacuna que contenga sarampión, una dosis de la vacuna contra la rubéola y una dosis de la vacuna contra las paperas. Los estudiantes de años de edad, con dos dosis cumplen con el requisito si recibieron la vacuna contra la hepatitis B para adultos (Recombivax). Deben documentarse claramente la dosis y el tipo de vacuna. Dos (2) dosis de 10 mcg/1.0 ml de Recombivax. La 1. a dosis de la vacuna contra la varicela debe recibirse en o después del 1. er cumpleaños. Para el kínder-4. o y 7. o -11. o grado, se requieren dos dosis. Se requiere una (1) dosis para todos los demás niveles de grado. Se requieren dos dosis para todos los estudiantes que reciban la 1. a dosis en o después de los 13 años de edad. La 1. a dosis de la vacuna contra la hepatitis A debe recibirse en o después del 1. er cumpleaños. Recibir la dosis hasta (e inclusive) 4 días antes del cumpleaños satisfará el requisito de inmunización para entrar a la escuela. La confirmación serológica de la inmunidad al sarampión, las paperas, la rubéola, la hepatitis B, la hepatitis A o la varicela o la evidencia serológica de infección son aceptables en lugar de la vacuna. La enfermedad previa puede documentarse con una declaración escrita de un médico, una enfermera escolar o el padre o tutor del niño que diga algo como: "Esto es para verificar que (nombre del estudiante) tuvo varicela el (fecha) o por esa fecha y no necesita la vacuna contra la varicela". Dicha declaración escrita será aceptable en lugar de todas las dosis requeridas de la vacuna contra la varicela.

19 Exenciones La ley permite que (a) los médicos redacten una declaración en la que expongan que la vacuna o vacunas requeridas serían médicamente dañinas o perjudiciales para la salud y el bienestar del niño o de una persona que vive en la casa y que (b) los padres o tutores elijan una exención de los requisitos de inmunización por razones de conciencia, incluso creencias religiosas. La ley no permite que los padres o tutores elijan una exención simplemente por inconveniencia (por ejemplo, si se pierde un registro o éste está incompleto y sería mucha molestia ir con un médico o clínica para corregir el problema). Las escuelas y las guarderías deben mantener una lista actualizada de los estudiantes con exenciones, de forma que se les pueda excluir durante emergencias o epidemias declaradas por el director de salud pública. Encontrará instrucciones para solicitar la declaración jurada de exención oficial que debe ser firmada por los padres o tutores que elijan la exención por razones de conciencia, incluso creencias religiosas, en La declaración jurada de exención original debe rellenarse y presentarse a la escuela o guardería. En el caso de los niños que soliciten exenciones médicas, deben presentar una declaración escrita del médico a la escuela o guardería. Inscripción provisional Todas las inmunizaciones se deben finalizar antes de la primera fecha de asistencia. La ley exige que los estudiantes estén completamente vacunados contra las enfermedades señaladas. Un estudiante se puede inscribir provisionalmente si el estudiante cuenta con registro de inmunización que indique que el estudiante ha recibido al menos una dosis de cada vacuna apropiada para la edad específica que esta regla exija. Para seguir inscrito, el estudiante debe completar las dosis posteriores requeridas de cada serie de vacunas conforme al calendario y tan rápidamente como sea médicamente posible y proveer comprobante suficiente de la vacunación a la escuela. Una enfermera escolar o un administrador escolar revisará el estado de inmunización de un estudiante inscrito provisionalmente cada 30 días para garantizar el cumplimiento ininterrumpido en la finalización de las dosis de vacunas requeridas. Si, al final del periodo de 30 días, un estudiante no ha recibido una dosis posterior de la vacuna, el estudiante no está cumpliendo y la escuela excluirá al estudiante para que no asista a la escuela hasta que se administre la dosis requerida. Documentación Dado que se usan muchos tipos de registros de inmunización personales, cualquier documento es aceptable si un médico o el personal de salud pública lo ha validado. Debe registrarse el mes, día y año en que se recibió la vacuna en todos los registros de inmunización escolares creados o actualizados después del 1 de septiembre de Texas Department of State Health Services Immunization Branch MC-1946 P O Box Austin, TX (800) Stock No Rev. 03/2013